Common Health and Illnesses in Pediatrics

As parents ourselves, we know that nothing is more distressful than having a child who’s ill or injured.  Thankfully, most childhood illnesses and injuries aren’t life-threatening. But it doesn’t mean that you don’t want them feeling better and on the road to recovery right away.

There are many sources of information online about common health and illnesses in pediatrics, but we’ve compiled our own list of the most common ailments that many parents may have experience with during their child’s growing years. Please note that our summaries, while striving to provide complete information, are by no means a substitute for seeking medical care for your child’s special needs and special health care needs.

For urgent questions about your child’s health or symptoms, please contact us at (919) 787-9555 for immediate medical help from one of our doctors or our nurse practitioner.  For any non-urgent matters/appointment, contact us at (919) 787-9555. 

Click on the links below for more information on:
Antibiotic usage
Colds
Cough
Croup
Diaper Rash
Diarrhea
Ear infections
Eczema
Fever

Head Injury
Hives
Pink Eye
Sore Throat
Teething

 

Antibiotic Usage

Antibiotics are strong medicines that can kill bacteria. Specific formulations are better suited to treat specific bacterial infections. Antibiotics have no use in treating viral infections, which cause most childhood infections. Typical viral infections are colds, croup, coughs, fevers, sore throats, vomiting and diarrhea. Typical bacterial infections are ear infections, strep throat, sinus infections and some pneumonies.

Antibiotic overuse is a problem that leads to resistance. Bacteria can become “smart” and no longer respond to certain antibiotics when they are used unnecessarily. This causes a community wide problem because we then have bacteria causing illness that many antibiotics can’t treat. Because of this, you should always give the full dose of antibiotics if they are prescribed to your child and then throw away any that are left over. You should not save them for another time or give them to another
person.

The most common side effects of antibiotics are diarrhea and an upset stomach. Some people are allergic to antibiotics and can develop hives or other rashes as well as vomiting. If you child develops any of these symptoms while on an antibiotic, please call the office so we can decide if they are allergic and mark their chart accordingly.

Colds

A cold is an upper respiratory infection caused by one of many, many viruses. The symptoms of a cold are fever, runny or stuffy nose, sore throat, cough, and red or draining eyes. Any or all of these symptoms can be present with different cold viruses. The fever usually occurs at the beginning of a cold and lasts for 3-5 days. The runny nose symptoms usually last a week or two and the cough can linger longer than that. Occasionally a cold will last long enough that a bacterial infection can develop such as an ear infection or a sinus infection. If you think this is the case, call the office so we can evaluate your child.

There is no medicine that makes a cold go away, but we try to keep children comfortable while their bodies are fighting off the infection. For your babies, saline nose drops and a bulb suction are the most effective and safest treatment. If the nose is running, you can just use the bulb suction to remove the mucous before feeds and sleep. If the nose is stuffy but not running, saline drops used before suctioning can help loosen thicker mucous or decrease some of the nasal swelling.

In children older than 2 or 3, over-the-counter cold medicines are sometimes helpful. Cough suppressants can be used at night to aid in sleep, but we prefer that children be allowed to cough during the day to help remove excretions. Decongestants are sometimes helpful when a child complains of facial pain or stuffy nose. Antihistamines are sometimes helpful with a runny nose, but they can make the child very sleepy, so are most useful at night. We often find that cold medicines have side effects that are more bothersome than the little bit of relief they offer, but Tylenol or Ibuprofen are useful for fever and pain relief. In older children, encourage them to blow their nose frequently and use saline nose spray if helpful.

Cough

Most coughs are caused by viral infections of the windpipe and bronchi or by drainage from the nose. Coughs can last a long time, usually 2-3 weeks before they go away. The cough can vary from a dry tickling cough to a very wet, productive cough. Cough suppressants can be used in children over the age of 2, and there are many formulations available over the counter. Delsym is a nice formulation because it lasts for 12 hours. Cough drops are nice for older children to use during the day because they can soothe the throat and help with a dry cough.

Occasionally a cough is caused by an infection in the lung tissue, also called pneumonia. This type of cough is usually accompanied by persistent fever, chest pain, rapid breathing or lethargy. If your child has any of these symptoms or his or her cough has lasted more than 3 weeks, please bring him in for evaluation.

Croup

Croup is a viral infection that causes swelling in the area of the vocal cords and windpipe. It is usually part of a cold but often starts very abruptly. The classic presentation is a healthy child who goes to sleep and then awakens suddenly in the middle of the night with a barking cough and noisy breathing called stridor. The child will often run a fever with the croup and usually has a runny nose as well. The croupy cough and stridor usually last about 3 or 4 days and are usually worse at night. The cough then typically turns into more of a wet sounding cough and the cold runs its course as usual lasting another 7-10 days.

Although the cough and stridor are very scary sounding, they are rarely dangerous. The best thing you can do if your child wakes up with these symptoms is calm them down. Once his or her breathing slows down, it will get quieter. Some people have tried taking a child out into the cold air if it is winter, or putting them in the bathroom with a steamy shower running. These are both appropriate interventions.

Croup can most often be managed at home by running a cool mist vaporizer at night and calming the child when they awaken coughing. If the stridor continues while your child is calm or you feel that his or her breathing is too fast even when they are calm, call the office for evaluation.

Diaper Rash

Almost every child will get a diaper rash at some point. Most are due to prolonged contact with moisture, bacteria and ammonia. To treat diaper rashes, change your child’s diaper frequently and leave his or her bottom open to air as much as possible. If the rash is really raw, you may want to avoid commercial diaper wipes and just use a wet washcloth for diaper changes. A barrier ointment containing zinc oxide can be applied to clean skin with diaper changes until the area heals. If the rash is not getting better in about 3 days, call for an appointment so we can evaluate whether something more serious is causing the rash.

Diarrhea

Diarrhea is defined as the sudden increase in the frequency and looseness of bowel movements and is usually caused by a viral infection of the intestines called gastroenteritis. It may or may not be accompanied by vomiting and fever. Diarrhea usually lasts from several days to a week regardless of the treatment. The main concern with diarrhea is dehydration, so treatment is aimed at increasing fluids.

Babies who develop frequent diarrhea are at higher risk of dehydration. An oral re-hydration solution (such as Pedialyte) should be used for 6-24 hours in bottle. Formula should be restarted after that in order to avoid electrolyte imbalance. In breastfed babies, breastfeeding should continue, often in more frequent intervals. You may occasionally need to supplement with pedialyte, but that is usually not the case. In older children with diarrhea, Pedialyte or Gatorade may be given. Sometimes milk products or very sweet juices can make the diarrhea worse. The goal of pushing fluids would be to ensure adequate urine output (at least 3 urinations per day).

If diarrhea continues more than a day or two in babies or more than 2 or 3 days in older children, please bring them in for evaluation.

Fever

Fever is a very common symptom in childhood and does not in itself cause any harm. Fever indicates that the body is fighting off an infection, caused by a virus or bacteria. Teething does not cause fever. Most often, a fever occurs at the beginning of a viral illness and can last 3-5 days. We worry about fever if there are no other symptoms occurring with it, like runny nose and cough or vomiting and diarrhea. We also worry about fever in very young babies, particularly those under 2 months of age
who have not had any vaccines yet.

Typical fevers in children range from 100.4 to 104. The height of the fever does not indicate the seriousness of the infection. When children have fever, they are less likely to drink and eat, and are at risk of becoming dehydrated. Sometimes children will act listless or say things that don’t make sense when they have a fever. If your child does not act normally after being giving Tylenol and fluids, call the office and let us know. To take a temperature in children under 3 years of age, we recommend a rectal thermometer. For children over 3, oral temperatures are preferred, but axillary (under the arm) can also be taken.

To treat fever, give extra fluids and dress your child in light weight clothing. You can give acetaminophen at any age or ibuprofen above 6 months of age. Recommended dosing is on the side of the box or in our newborn books. The goal of treating temperatures is to make the child comfortable and keep them hydrated. You may not be able to get the temperature completely to normal during the illness, but that is okay. Do not give Tylenol to a baby under 2 months of age without calling the office first.

Teething

All babies start chewing and drooling around 3 or 4 months of age, and the first tooth can appear anytime between 3 months and 1 year. Most teething is painless and does not interfere with sleep. Since teeth erupt continuously between 6 months and 2 years, many unrelated illnesses are blamed on teething. Things you may want to try to help your child with the teething process are gum massage, teething rings, teething gels and acetaminophen. If you find the swollen gum, you can massage it vigorously for 2 minutes at a time. You can also use ice to massage the gums. Teething rings, either cold or room temperature, wet and chilled washcloths, or other textured objects can be used for your baby to chew on. Teething gels and acetaminophen should only be used for short periods of time.

Sore Throat

Sore throats are very common and usually occur with viral illnesses like colds. Sore throats are common early in a cold or when mucous is running down the back of the throat. About 10% of sore throats are caused by the strep bacteria. This can be tested in the office and requires an antibiotic to treat and to avoid subsequent complications.

Both viral and strep sore throats can cause a red throat. Usually, but not always, viral sore throats are accompanied by cold symptoms. Strep throat, on the other hand, is usually accompanied by headache, stomach ache, fever and vomiting. If your child has a sore throat and any of these strep symptoms, call the office so we can evaluate
your child.

Ear infections

Ear infections come in two main varieties: middle ear infections and outer ear infections, also called swimmer’s ear. Although they both involve the ear, they have different causes, symptoms and treatment.

Middle ear infections develop when a child has congestion which causes the eustachian tubes that run from the ear to the throat to function poorly. A vacuum develops in the middle ear space which causes fluid to build up in there. This fluid is a nice place for bacteria and viruses to grow. When this happens, the ear drum gets red and stretches out causing pain. The pain is often worse when the child lies down. Most often ear infections develop after a child has had a cold for at least a few days. Usually we will need to treat this type of ear infection with an antibiotic taken by mouth, although occasionally these infections will resolve on their own.

Swimmer’s ear, on the other hand, is actually a skin infection that develops in the external ear canal (outside of the ear drum). This usually develops after a child has done a lot of swimming and the ears stay warm and wet, creating an environment where bacteria can grow. This type of infection is treated with an ear drop that is applied to the ear canal several times per day to cure the skin infection. Swimmer’s ear can be prevented by using an over- the-counter ear drop or by making your own with half rubbing alcohol and half white vinegar.

Both types of ear infections can be very painful and will likely need Tylenol or Ibuprofen for the first few days of treatment. A middle ear infection is often accompanied by a fever, whereas an outer ear infection rarely is.

Vomiting

Vomiting is usually caused by a viral infection of the stomach or by eating something that disagrees with your child. Often the virus that causes vomiting will have diarrhea and fever as well. Vomiting usually lasts 6 to 24 hours. If vomiting occurs just once, you can continue to feed and hydrate your child regularly but if it becomes clear that the vomiting is going to continue, you will need to make some dietary changes. For bottle fed babies, stop feeding formula and change to pedialtye. Start off by giving one teaspoon of Pedialyte every 5 – 10 minutes while your child is awake. If this is tolerated without vomiting for several hours, you can increase the amount given slowly. After 24 hours on Pedialyte you will need to change back to formula. If your baby is still vomiting at that point, please call the office for an evaluation. In breastfed babies, continue to offer breastmilk but in very short feeding sessions and more often than usual.

In older children, offer ice chips or small sips of gatorade, water or decaffinated soft drinks. Avoid solid foods until your child has stopped vomiting for 6 hours or more. If persistent vomiting continues for more than 24 hours, of if you child appears dehydrated, call the office for evaluation. If your child has blood in the vomit or complains of abdominal pain that lasts longer than 4 hours, call immediately.

Pink Eye

Pink eye or conjunctivitis is an inflammation of the outer layer of the eye or inside of the eyelid. Occasionally it is caused by a bacteria and is fairly contagious. However, most of the time it is caused by the same type of virus that causes a cold and occurs with cold symptoms.

Eye drops will not help viral conjunctivitis. You can clean your child’s eyes with a wet cotton ball or clean washcloth when they wake up in the morning and all the discharge has crusted in the eyelashes. If the eye is pink but not painful and does not continue to drain throughout the day, you can just observe the child at home.

Viral pink eye should improve as the cold improves. If the eye is painful and is tearing or draining or does not seem to have any other cold symptoms, call the office for an appointment so we can see if antibiotic drops are necessary.

Hives

Hives is another word for urticaria, a very itchy and splotchy red rash. Hives are caused by a variety of things such as allergic reactions, viruses and strep bacteria. Most times the cause of the hives is never known. Approximately 10% of children develop hives at some point and most of them will never have it again. Occasionally it can become chronic and last a long time. Most of the time hives last from 24 hours to 4 or 5 days. Benadryl liquid can be used for comfort, but when it wears off the hives will return. Eventually the hives go away and no other medications are needed.

Eczema

Eczema is an inherited type of sensitive skin. It tends to run in families in which some members have asthma and allergies. Eczema flares can be caused by food allergies, environmental allergies, irritating substances (soaps, detergents) or cold, dry air. It is often called “the itch that rashes” because eczema usually starts with itchy skin that kids scratch and then the rash breaks out.

The mainstay of eczema treatment is moisturizing the skin. This can be accomplished by avoiding hot, long baths and by applying a thick, greasy moisturizer once to twice a day. Try to avoid moisturizers with a lot of color or scent to them. If the eczema is not responding to this, we may need to start your child on a steroid cream to reduce the inflammation.

Head Injury

Every child will strike their head at some point in his or her life. Most of the time the injury is minor and nothing more than observation is required. Often a large “goose egg” will develop at the site of the injury because the scalp has a very large blood supply and bruises easily. If your child cries immediately and then acts normally after such an injury, you can observe the child at home. If, however, your child loses consciousness, vomits, or has any changes in normal activity or behavior (changes in speech, walking or making sense), you should call the office immediately. A little headache is acceptable after a head injury and tylenol can be given. But, a headache that doesn’t go away after 12 hours or seems to be worsening is cause for concern, so please call the office.